'When you hear hoofbeats, think of horses not zebras' - the old adage is well-known to GPs but what should you do when faced with a zebra, not a horse? Consultant cardiologist Professor Robert Tulloh and GP Dr Louise Tulloh kick off our new series with their advice on how to catch Kawasaki disease in general practice.

GPs should offer a course of leukotriene receptor antagonists (LTRA) before a combination inhaler when stepping up asthma control, recommends NICE in draft guidance.

Current practice is to offer combined long-acting beta-agonist and inhaled steroid treatment to patients with persistent asthma symptoms, but NICE now say that GPs should consider using an oral LTRA first.

If a person’s asthma remains uncontrolled with LTRAs then they can add or move to LABA/ICS combination inhalers. Children under five should be referred to a specialist if adding LTRA has not controlled their symptoms.

NICE estimates that £3m a year could be saved for every 10,000 people who take up the new recommendation and the guidance is out for public consultation until 16 February 2017.

Professor Mark Baker, director of the NICE centre for guidelines said: ‘Millions of people need treatment for their asthma which comes at a price. We also need to make sure that we make the best use of NHS resources and our guidance is the first to set out what the most clinical and cost-effective options for treating asthma are.

‘We now want to hear from all those who provide care for people with asthma in the NHS to ensure that the views of those this guidance will affect are fully considered.’

Readers' comments (1)

Perhaps there is some senses of doing this . Many asthmatics also suffer from allergic rhinitis as one of the spectrum conditions of atopy. This causes some disruptive upper respiratory symptoms . Though not being helpful in atopic eczema , leukotruene receptor inhibitor is certainly indicated in urticaria . Many combined LABA/ICS inhalers are only licensed from age 12 which is not practical in some young brittle asthmatics. Yes , the ceiling of daily dose of ICS 400mcg in children is there for the concern of growth stunning but it needs some flexibility in severe cases with frequent exacerbations and poor quality of life .Certainly , LTRA can fit in well( in rightly chosen individual) after ICS was increased to certain maximum. Question here is simply whether LTRA first or LABA first?